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‫‪Republic Of Algeri The People’s Democratic‬‬ ‫اﻟﺠﻤﮭﻮرﯾﺔ اﻟﺠﺰاﺋﺮﯾﺔ اﻟﺪﯾﻤﻘﺮاطﯿﺔ اﻟﺸﻌﺒﯿﺔ‬

‫‪Ministry Of Higher Education And Scientific Research‬‬ ‫وزارة اﻟﺘﻌﻠﯿﻢ اﻟﻌﺎﻟﻲ و اﻟﺒﺤﺚ اﻟﻌﻠﻤﻲ‬
‫‪Abbes Laghrour University Khenchela‬‬ ‫ﺟﺎﻣﻌﺔ ﻋﺒﺎس ﻟﻐﺮور ﺧﻨﺸﻠﺔ‬
‫‪Faculty of Sciences and Technology‬‬ ‫ﻛﻠﯿﺔ اﻟﻌﻠﻮم و اﻟﺘﻜﻨﻮﻟﻮﺟﯿﺎ‬
‫‪N......../A L U K/F L P S/2021/2022‬‬ ‫رﻗم‪ / ........:‬ج ع ل خ‪/‬ك ع ت ‪2022/2021/‬‬

‫ﻣﺼ ﺔ ﻧﺨﺮاط ﻟﻠ ﻠﻴﺔ‬

‫اﺳﺘﻤﺎرة اﳌﻌﻠﻮﻣﺎت‬

‫‪.........................................................................................................................................................................‬‬ ‫ﺳﻢ ‪:‬‬ ‫‪......................................................................................................................‬‬ ‫اﻟﻠﻘﺐ ‪:‬‬

‫‪........................................................................................................................................................................................................................................................................‬‬ ‫ﺗﺎر ﺦ و ﻣ ﺎن اﳌﻴﻼد ‪:‬‬

‫‪............................................................................................................................‬‬ ‫اﺳﻢ ب ‪ ............................................................................................................................ :‬اﺳﻢ م ‪:‬‬

‫‪...........................................................................................................................................................................................................................................................................................................................‬‬ ‫اﻟ ﺎﺗﻒ ‪:‬‬

‫‪..................................................................................................................................................................................................................................................................................‬‬ ‫‪:‬‬ ‫اﻟﻌﻨﻮان اﻟ‬

‫‪.................................................................................................................................................................................................................................................................................................‬‬ ‫اﻟ ﻳﺪ ﻟﻜ و ﻲ ‪:‬‬

‫‪.................................................................................................................................................................................................................................................................................................‬‬ ‫ﻴﻞ ‪:‬‬ ‫رﻗﻢ اﻟ‬

‫‪....................................................................................................................................................................................................................................................................................................................................‬‬ ‫اﻟﺴﻨﺔ ‪:‬‬

‫‪.............................................................................................................................................................‬‬‫اﻟﺴﻨﺔ اﻟﺪراﺳﻴﺔ ‪2022/2021......................................................................... :‬‬

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